OBJECTIVES: The out-of-pocket (OOP) expenses for care related to breast cancer can be burdensome for survivors. We know little about the kind and amount of OOP for survivors’ care, health maintenance and management of side effects. The objective is to report on expenses in 150 participants in the Rural Breast Cancer Survivor Intervention (RBCS), a clinical trial evaluating a psychoeducational quality of life intervention. METHODS: Breast cancer survivors recruited for the trial were 1-3 years post diagnosis, at least 21 years old and residing in rural Florida. OOP data collected at baseline included expenditures for Medical Care (hospital, ER, and doctors’ bills, medical supplies, drugs, travel to treatment, physical therapy), Counseling and Health Maintenance (family or individual support, alternative treatments, nutritional counseling, exercise or gym/health club memberships, genetic testing/counseling), Side Effect Management (wigs, prostheses), and Home Maintenance (house cleaning/cooking, additional maintenance or child care). We report mean monthly costs for the period from diagnosis to baseline. RESULTS: Of 150 mostly white women, 91.3% were insured, 30.0% had incomes >$50,000, and 60.7% were >24 months post diagnosis.  A total of 94.7% reported OOP spending (mean $119.6, median $53.6). Medical Care costs and Home Maintenance costs were highest, $129.3 and $87.6, respectively, for women 25-36 months post diagnosis. Medical Care costs were lowest for women >49 months post-diagnosis, $33.7, and Home Maintenance costs were lowest, $15, for women 10-24 months post-diagnosis. Counseling and Health Maintenance and Side Effect Management costs were highest ($43 and $14, respectively) for women 10-36 months post-diagnosis and lowest ($20 and $8) for women 37-48 months.   CONCLUSIONS: Rural breast cancer survivors continue to have OOP costs related to their disease years after diagnosis. Understanding how and how much they spend is important information to be considered in cost-effectiveness analyses of interventions to improve their quality of life.